To assess the effectiveness and safety of EUS-guided endoscopic ablation of focal pancreatic lesions.

A prospective assessment of treatment outcomes of all patients in whom EUS-guided ablation of a focal pancreatic lesion was performed between 2019 and 2025 at the Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University in Toruń.

Endoscopic ablation of 26 focal pancreatic lesions was performed in 21 patients (14 women, 7 men; mean age 39.77 [21–75] years). Seventeen patients had solitary lesions, and four had multifocal lesions. Eight lesions were located in the pancreatic head, 12 in the body, and 6 in the tail. Histopathology revealed G1 neuroendocrine tumors in 14 patients, while in the remaining 7 patients metastatic renal cell carcinoma or breast cancer lesions were identified. The mean size of the focal lesions was 11 (7–20) mm. In 9 patients, EUS-guided radiofrequency ablation (EUS-RFA) of 12 pancreatic lesions was performed. In 12 patients, ablation of 14 lesions using 98% ethanol was carried out. Technical success was achieved in 23/26 (88.46%) lesions in 19/21 (90.48%) patients. Complications occurred in 4/21 (19.05%) patients. The mean follow-up was 864 (88–1464) days. Long-term success was achieved in 17/21 (80.95%) patients.

EUS-guided endoscopic ablation of focal pancreatic lesions is an effective and safe treatment option in selected patients and represents an alternative to surgical management.